Source · Select Committees · Housing, Communities and Local Government Committee
Second Report - Long-term funding of adult social care
Housing, Communities and Local Government Committee
HC 19
Published 4 August 2022
Recommendations
2
Accepted
The Government provided vital additional funding to the adult social care sector during the pandemic,...
Recommendation
The Government provided vital additional funding to the adult social care sector during the pandemic, and we appreciate that the additional covid-19 funding cannot continue indefinitely. However, the Government’s own guidance that care workers should self-isolate if they test positive …
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Government Response Summary
The government states that at the Autumn Statement 2022 it made up to £7.5 billion of additional funding available over two years to support adult social care and discharge.
Ministry of Housing, Communities and Local Government
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3
Accepted
The Government is focused on long-term reform of adult social care, but in order to...
Recommendation
The Government is focused on long-term reform of adult social care, but in order to get to the future it needs to save the sector from the brink of collapse. Covid-19 has highlighted the underlying structural challenges of rising demand, …
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Government Response Summary
The government is making available more funding for adult social care through general taxation and increased Council Tax flexibilities, with up to £7.5 billion of additional funding over two years to support adult social care and discharge.
Ministry of Housing, Communities and Local Government
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8
Acknowledged
Para 59
While the Government has provided funding for its charging reforms, we received many concerns that...
Recommendation
While the Government has provided funding for its charging reforms, we received many concerns that it has underestimated the combined cost of introducing a new cap and more generous means test, commencing Section 18(3) of the Care Act 2014 in …
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Government Response Summary
The government acknowledges the committee's interest in proposals to improve fee transparency and describes existing initiatives like the Market Sustainability and Fair Cost of Care Fund and the Market Sustainability and Improvement Fund, as well as a commitment to consider changing the CQC registration regulations to require greater fee transparency.
Ministry of Housing, Communities and Local Government
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9
Acknowledged
Para 60
It is nevertheless disappointing that people currently living in and paying for residential care, whose...
Recommendation
It is nevertheless disappointing that people currently living in and paying for residential care, whose payments before October 2023 will not count towards the cap, will now not be able to access local authority rates until 18 months later than …
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Government Response Summary
The government states they agree with the committee’s recommendation for market shaping to include a dedicated focus on outcomes-based commissioning and investing funding to strengthen local authority market-shaping, commissioning, and contract management capability.
Ministry of Housing, Communities and Local Government
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11
Acknowledged
Para 62
The Government should publish real-time and regular evaluation, both of the trailblazer scheme and of...
Recommendation
The Government should publish real-time and regular evaluation, both of the trailblazer scheme and of the charging reforms when they are rolled out more widely, so that local authorities can apply insights quickly and so that the Government can provide …
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Government Response Summary
The government states it understands the benefits for councils of a Local Government Finance Settlement (LGFS) spanning multiple years and will aim to provide a multi-year funding settlement wherever possible in recognition of its importance to councils’ budget setting processes and to delivering excellent public services.
Ministry of Housing, Communities and Local Government
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12
Acknowledged
Para 63
Given the Government’s investment in the fair cost of care, and our calls for further...
Recommendation
Given the Government’s investment in the fair cost of care, and our calls for further funding and for care providers to be compensated for their employer National Insurance Contributions of the Health and Social Care Levy, it is all the …
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Government Response Summary
The government acknowledges the desire for clarity on distribution reform but states that they will not be proceeding with the Review of Relative Needs and Resources or Business Rates Reset during this Spending Review, focusing instead on stability and clarity.
Ministry of Housing, Communities and Local Government
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14
Acknowledged
Para 73
As well as the desperate human impact on those needing, receiving, and providing care, the...
Recommendation
As well as the desperate human impact on those needing, receiving, and providing care, the underfunding of adult social care has led to many councils having to cut other public services in order to do their best to meet their …
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Government Response Summary
The government restates its commitment to the 10-year vision for adult social care set out in the People at the Heart of Care white paper and highlights actions being taken over the next two years to take the next step toward person-centred care.
Ministry of Housing, Communities and Local Government
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15
Accepted
Para 74
We recognise the benefits of raising a proportion of funding for adult social care locally.
Recommendation
We recognise the benefits of raising a proportion of funding for adult social care locally. As we have argued in previous reports, we support greater fiscal devolution. In finding the right balance of funding sources for adult social care, however, …
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Government Response Summary
The government states that overall funding for health and social care will be maintained at the same level as if the Levy was in place, and that savings from delaying implementation of charging reform will be distributed via the existing Social Care Grant that supports local authorities to meet the current pressures in social care.
Ministry of Housing, Communities and Local Government
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16
Accepted
Para 75
One-year funding settlements and short-term grants are hampering local authorities’ ability to plan and to...
Recommendation
One-year funding settlements and short-term grants are hampering local authorities’ ability to plan and to deliver value for money, which in turn affects local care markets as it makes it more difficult for local authorities to enter longer term contracts …
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Government Response Summary
The government states that in developing the People at the Heart of Care white paper, it engaged extensively with other government departments, and has worked closely with colleagues across government since the white paper publication to produce the recently published Next Steps to Put People at the Heart of Care plan.
Ministry of Housing, Communities and Local Government
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17
Acknowledged
Para 76
The geographical inequity of relying on council tax to provide the majority of funding for...
Recommendation
The geographical inequity of relying on council tax to provide the majority of funding for adult social care is compounded by an out-of-date adult social care relative needs formula. The Government must update the adult social care relative needs formula …
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Government Response Summary
The government states that they remain committed to providing care and support in a person’s own home, but have taken the difficult decision to not progress with the £300 million investment in housing, announced in the white paper, in order to prioritize spending on the reforms we believe are most needed.
Ministry of Housing, Communities and Local Government
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18
Accepted
The Department for Health and Social Care is drip-feeding numerous policy changes in adult social...
Recommendation
The Department for Health and Social Care is drip-feeding numerous policy changes in adult social care, many of which are welcome, but many of which will have a significant impact on local authorities in terms of their spending and capacity. …
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Government Response Summary
The government states that National Planning Policy already makes clear that local authorities must plan for a range of housing needs, including the needs of older and disabled people, and that they do not intend to introduce statutory requirements at this time.
Ministry of Housing, Communities and Local Government
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19
Acknowledged
Para 85
Stakeholders have called for adult social care reform for years, and we commend the Government...
Recommendation
Stakeholders have called for adult social care reform for years, and we commend the Government for introducing many welcome initiatives such as around housing and data that could make a significant difference in the long-term. We are also pleased that …
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Government Response Summary
The government notes that the Older People’s Housing Task Force will provide an opportunity to consider detailed evidence of the operation of the planning system in supporting housing for older people and whether any changes are required, including in respect of use classes, but makes no firm commitments.
Ministry of Housing, Communities and Local Government
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23
Acknowledged
Para 99
The Government should create a separate taskforce for housing for working age disabled adults alongside...
Recommendation
The Government should create a separate taskforce for housing for working age disabled adults alongside the taskforce for housing for older people. Both taskforces should be accountable to both DLUHC and DHSC and should report to the Senior Responsible Officer …
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Government Response Summary
The government points to their 10-year white paper reform vision and states that they will invest up to an additional £25 million for unpaid carers. They are also taking steps towards implementing a new survey of unpaid carers.
Ministry of Housing, Communities and Local Government
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24
Deferred
Para 100
Despite guidance from the Government on planning for housing for older and disabled people, not...
Recommendation
Despite guidance from the Government on planning for housing for older and disabled people, not enough councils are producing plans or conducting sufficiently robust housing needs assessments. The Government should consider introducing statutory requirements for local authorities to produce plans …
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Government Response Summary
The government states it has no plans to carry out a review into carer’s assessments, stating that CQC assessment of local authorities’ delivery of their Care Act responsibilities will show how effectively local authorities are supporting unpaid carers.
Ministry of Housing, Communities and Local Government
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25
Not Addressed
The Government should consult on whether one or more Use Classes or sub-classes should be...
Recommendation
The Government should consult on whether one or more Use Classes or sub-classes should be introduced in order to unlock more development of different types of accommodation that is suitable for older and disabled people, and meets the demand within …
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Government Response Summary
The government's response discusses integrated care systems and budget arrangements, but does not address the recommendation to consult on Use Classes or sub-classes for accommodation suitable for older and disabled people.
Ministry of Housing, Communities and Local Government
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26
Accepted
The Minister for Care and Mental Health asserted that the chapter on the workforce in...
Recommendation
The Minister for Care and Mental Health asserted that the chapter on the workforce in the People at the Heart of Care White Paper is the Government’s social care workforce strategy, but the number of further calls for a social …
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Government Response Summary
The government agrees that ensuring there is holistic care that fits around people’s needs includes ensuring that people receive the right care and support, and can maintain healthy independent living, beginning with where they live, and the people they live with.
Ministry of Housing, Communities and Local Government
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28
Accepted
We welcome the addition of care workers, care assistants and domiciliary care workers to the...
Recommendation
We welcome the addition of care workers, care assistants and domiciliary care workers to the Shortage Occupation List, acknowledging that these roles are in short supply within the UK resident labour market. The Government should monitor the impact of adding …
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Government Response Summary
The government outlines existing funding allocated to support timely and safe discharge from hospitals through social care and reablement services, and integrated care boards commissioning step-down bed-based capacity.
Ministry of Housing, Communities and Local Government
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30
Accepted
The Government claims “the money is there” to support carers’ breaks, but the evidence we...
Recommendation
The Government claims “the money is there” to support carers’ breaks, but the evidence we received is that not enough carers are getting a break. There are many carers who have not had a break since the start of the …
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Government Response Summary
The government claims to already support carers through the Care Act 2014, the Better Care Fund, and an investment of up to £25 million for unpaid carers, stating the 2023-25 BCF framework will improve spend clarity.
Ministry of Housing, Communities and Local Government
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31
Accepted in Part
We recognise that it is not always easy to engage with people who do not...
Recommendation
We recognise that it is not always easy to engage with people who do not identify as “carers”, but more must be done to ensure that carers receive the support to which they are entitled, and that the support they …
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Government Response Summary
While recognizing the importance of supporting unpaid carers, the government does not plan to carry out a review of carer’s assessments, but will be implementing a new survey of unpaid carers and will use CQC assessments to show how effectively local authorities are supporting unpaid carers.
Ministry of Housing, Communities and Local Government
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33
Accepted
Para 142
We welcome the Joining up Care for People, Places and Populations White Paper and commend...
Recommendation
We welcome the Joining up Care for People, Places and Populations White Paper and commend the Government for making the integration of health and social care a policy priority. We particularly welcome the Government’s ambitions around shared outcomes, workforce integration, …
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Government Response Summary
The government states that much of the activity to integrate care should be driven by collaboration between commissioners and providers within integrated care systems (ICS) and will continue to work with place-based partnerships as they develop collaborative arrangements, including reviewing ICS boundaries in certain areas.
Ministry of Housing, Communities and Local Government
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34
Acknowledged
Para 143
Integration strategies should seek to integrate not just health and care but health, care and...
Recommendation
Integration strategies should seek to integrate not just health and care but health, care and housing. Ensuring there is holistic care that fits around a person’s needs includes preventing care needs from arising by having suitable housing, enabling people to …
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Government Response Summary
The government agrees that holistic care should include housing and highlights examples of integrated approaches in areas like Greater Manchester and states their Integrated Care Strategy guidance encourages integrated care partnerships to have a joined-up approach to housing.
Ministry of Housing, Communities and Local Government
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35
Accepted
Para 144
Barriers to data-sharing between health and social care have been a long-standing challenge, so we...
Recommendation
Barriers to data-sharing between health and social care have been a long-standing challenge, so we particularly welcome the Government’s ambition to have shared care records for all citizens by 2024. It is vital that this ambition becomes a reality. 80 …
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Government Response Summary
The government claims to be addressing this already through the Digital Health and Care Plan, funding for integrated care systems to acquire shared record systems, and supporting local systems to develop care planning systems, including patient and carer input.
Ministry of Housing, Communities and Local Government
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Conclusions (14)
1
Conclusion
Accepted
Para 12
The covid-19 pandemic has had a severe impact on adult social care. People have received less care and often care workers have been compelled to deliver only the basics. More people are going without care and many people’s needs are increasing significantly. Social care workers and unpaid carers are burnt …
Government Response Summary
The government states that throughout the pandemic they made available over £2.9 billion in specific COVID-19 funding to support the adult social care sector.
4
Conclusion
Acknowledged
Para 38
The Rt Hon Boris Johnson MP said as Prime Minister that he would fix the crisis in social care once and for all. We commend the Government for attempting to prevent unpredictable and catastrophic care costs for people and introducing reforms to the sector where previous Governments failed to act. …
Government Response Summary
The government acknowledged the concerns around the impact of charging reforms and stated they have provided funding for charging reforms, but do not address the concerns that they have underestimated the combined cost of introducing a new cap and more generous means test, commencing Section 18(3) of the Care Act 2014 in respect of residential care, and the fair cost of care.
5
Conclusion
Accepted
Para 39
The covid-19 pandemic had the effect of raising public awareness of adult social care. It also achieved general support for a tax increase specifically to plug the long- standing funding gap. However, the Government has missed this opportunity. It has done so firstly by allocating the vast majority of the …
Government Response Summary
The government states that the savings from delaying the implementation of charging reform are being retained in local authority budgets to help them meet the current pressures in social care, with additional funding being provided.
6
Conclusion
Acknowledged
Para 40
We do not wish to pit the NHS and adult social care against one another. The two systems are interdependent and each needs to be adequately funded to reduce pressure on the other. Wherever the money comes from—from allocating a higher proportion of levy proceeds to social care, or from …
Government Response Summary
The government recognises the committee’s concerns around the impact of charging reforms on social care assessors and will work with IT suppliers and local authorities, supporting local areas to trial and invest in innovative approaches to reforming operating models and to improving the recruitment and training of the adult social care workforce.
7
Conclusion
Acknowledged
We do not accept the Government’s position that care providers should not be compensated for employer National Insurance Contributions in relation to the Health and Social Care Levy simply because they are, on the whole, private businesses. We heard again and again that there should be parity of esteem between …
Government Response Summary
In light of the new timeline to implement charging reform, the government will be reviewing the delivery plan and considering how to ensure that insights from Trailblazers can be effectively fed back into the development of delivery to refine or adapt our approach to implementation.
10
Conclusion
Accepted
Para 61
While the changed timetable for rolling out Section 18(3) will help to stagger the additional assessments local authorities will need to conduct, we are nevertheless concerned about local authorities’ capacity to conduct tens of thousands of additional assessments, particularly given the size of the backlog that already exists. We are …
Government Response Summary
The government states it is committed to addressing the pressures facing social care and continues to provide significant additional grant funding to councils.
13
Conclusion
Acknowledged
While achieving a fair price of care is vital, price should not be the driving factor in commissioning care. Reforms in relation to improvement and market shaping should include a dedicated focus on outcomes-based commissioning, drawing on existing good practice by local authorities. (Paragraph 64) Local government finance
Government Response Summary
The government recognizes the concerns of local government and notes the delay to planned adult social care charging reforms. They will comply with the New Burdens Doctrine for relevant aspects of the adult social care reform programme.
20
Conclusion
Acknowledged
Para 86
The lack of information about how the reforms add up to £5.4 billion, why each reform was allocated the amount it was allocated, and how funding will be distributed, does little to instil confidence that the Government has thought through its plans. We have expressed our concerns numerous times about …
Government Response Summary
The government emphasizes that local authorities are responsible for ensuring sufficient workforce capacity to meet care needs in their area, and highlights the measures they are taking subject to monitoring and evaluation.
21
Conclusion
Acknowledged
Given how fundamentally social care policies made by DHSC affect local authorities’ capacity, budgets, and residents, it is vital that DHSC and DLUHC work together closely on developing and delivering such policies. We were struck by the discrete division of answers to questions by Ministers, who rarely supplemented one another’s …
Government Response Summary
The government acknowledges the importance of health and care staff and integrated care systems working with local authorities, but emphasizes the distinct nature of the social care sector as primarily private.
22
Conclusion
Deferred
Para 98
We welcome the Government’s commitment to “making every decision about care is a decision about housing”, but we are concerned that currently the Government is not putting this into practice. The detail on the housing policies in the People at the Heart of Care White Paper and how their funding …
Government Response Summary
The government has noted the Migration Advisory Committee’s (MAC) recommendation that care workers’ inclusion on the shortage occupation list should not automatically expire after 12 months and commissioned the MAC to review the SOL.
27
Conclusion
Accepted
Para 118
We heard repeatedly that an absolutely critical lever for stabilising the adult social care market was tackling staff shortages and low retention. This would widen access to care and help to give unpaid carers a much-needed break. There is also the very real risk that the Government’s charging reforms do …
Government Response Summary
The government welcomes the committee’s interest in shared care records and notes its Digital Health and Care Plan sets out that health and care professionals will have access to a comprehensive view of a person’s health record by April 2025.
29
Conclusion
Acknowledged
Para 128
Our broken care system is held up by unpaid carers doing vital work out of love and pride. The cost to them can be financial, physical, and emotional. The cost to our economy of carers leaving the workforce is over £3 billion each year—money that could be invested in adult …
Government Response Summary
The government recognizes the vital role of unpaid carers and the importance of supporting them and highlights the Care Act 2014 and Better Care Fund (BCF) as ways they are providing support, and will look to improve the clarity and transparency of spend on unpaid carers through BCF reporting requirements and activity data.
32
Conclusion
Acknowledged
Para 141
During this inquiry we heard about a proposal for a national care service, under which health and social care would be delivered by the same organisation. This would be similar to systems in place in Northern Ireland and Wales. This proposal was roundly dismissed by our witnesses. We support the …
Government Response Summary
The government recognizes the importance of collaboration between commissioners and providers within integrated care systems (ICS) and will provide further support and advice to help places develop their approaches where needed, including reviewing ICS boundaries in certain areas.
36
Conclusion
Accepted
We are not reassured by the Director General for Adult Social Care’s comments that some places have found ways to continue discharge to assess funding from their own funding streams, not least by her admission that these workarounds are only short-term and only “for the bits of it they think …
Government Response Summary
The government acknowledges the positive impact of Discharge to Assess funding, stating they allocated £500 million in 2022-23 and provided £200 million to integrated care boards, and are providing £1.6 billion over 2023-24 and 2024-25.